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Hollywood’s Dr. House meets Germany’s Dr. Juergen Schaefer

Two mysterious cases right out of the medical drama House were described Tuesday in two of the world’s most prestigious medical journals, both involving people poisoned by the cobalt in their hip joint replacements.

What’s killing Candice Bergen? In season seven of the medical drama House, her character shows up at the cranky-but-brilliant doctor’s hospital with a mysterious heart ailment. With just minutes left in the episode, she is already losing consciousness when Dr. House finally diagnoses the problem: cobalt poisoning, caused by the metal in her artificial hip.

This may seem plausible only in the implausible universe of Hollywood medical shows. But on Tuesday, two real-life cases were described in two of the world’s most prestigious medical journals, the Lancet and the New England Journal of Medicine — both involving people poisoned by the cobalt in their hip joint replacements.

The Lancet case was diagnosed in May 2012, the same month Fox aired the final episode of House. For one year, a 55-year-old construction business owner in Germany had been bouncing from doctor to doctor but no one could figure out why he was going deaf, blind and suffering from severe heart failure.

In a case of art-imitating-life-imitating-art, he was finally referred to Dr. Juergen Schaefer, known in his homeland as the “German Dr. House.”

And Schaefer recognized the symptoms within five minutes — partly because the University of Marburg professor had recently shown the cobalt poisoning episode of House to his medical students.

“This was an easy diagnosis once you know it — like from Dr. House,” said Schaefer, a cardiologist and intensive care specialist, in a phone interview. “If you saw this one, and if you kept in your mind this terrible disease, then you don’t forget it.”

Like Hugh Laurie’s character on the show, Schaefer specializes in diagnosing rare and unusual diseases. He has also spent the past five years teaching a university seminar called “Dr. House Revisited — or: would we have saved the patient in Marburg as well?”

His intriguing seminar has made local headlines, earned him two prestigious awards, and even landed him a book deal (Housemedizin, published by Wiley).

Several years ago, Schaefer tried to organize a lecture on diagnosing rare diseases but it was attended by only 10 or 15 students. In other words, only people who “you would call nerds, I guess,” he says.

But Schaefer and his wife, who is also a doctor, had recently started watching House, sometimes competing to diagnose the bizarre medical problems, which are often based on real-life cases, according to Schaefer.

The couple often found themselves discussing the fictional medical scenarios well after the episodes ended so Schaefer thought maybe the television show would also generate interest amongst his students. He created his House-inspired seminar and it has since become a post-secondary hit, attended by as many as 50 to 60 students.

As for Schaefer’s patient, he has since had his metal hip joint removed. While he hasn’t regained his hearing or sight, his heart function has improved and the cobalt levels in his blood has plummeted.

Schaefer said he was disappointed that so many doctors failed to diagnose his patient, however. In the case described in the New England Journal of Medicine, cobalt poisoning was also never considered until after the 59-year-old patient had a heart transplant — a serious medical procedure that could have been avoided had cobalt toxicity been diagnosed, Schaefer believes.

Schaefer said cobalt toxicity caused by faulty hip joint replacements is probably a growing and “unseen threat.” There are roughly a million patients around the world with “metal-on-metal” hip replacements, according to the New England Journal of Medicine, and Schaefer’s hospital alone has seen five cases of cobalt toxicity in the last two years.

In Schaefer’s experience, the most serious cases involve patients who were originally given ceramic hip replacements but had broken the head (the round part at the end of the femur), which their surgeons decided to replace with metal. Schaefer said orthopedic surgeons are not supposed to mix ceramic and metal hip parts; the ceramic sockets can act like sandpaper, essentially grinding the metal balls with every step and releasing cobalt ions into the body.

Her recently brought his patient into his seminar and had his students try their hand at diagnosing him. He was pleased with the results.

“Four of them argued probably he has some type of intoxication, maybe heavy metal intoxication,” he said. “I was so proud.”

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